Morris Andrew Mark
Division of Infectious Diseases, Department of Medicine, Michael G. deGroote School of Medicine, McMaster University, McMaster Clinic 625, Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
Curr Infect Dis Rep. 2006 Jan;8(1):14-22. doi: 10.1007/s11908-006-0030-8.
Infective endocarditis (IE) is an infection of the endocardial surface, usually involving heart valves and/or prosthetic intracardiac devices. Although much emphasis has been placed on antimicrobial prophylaxis prior to dental work to prevent IE, the evidence supporting this approach and its effectiveness are lacking. Resulting in valvular dysfunction, continuous bacteremia with constitutional features, embolic phenomena, and immune-mediated disease, diagnosis of IE requires careful history taking, physical examination, and utilization of echocardiography, blood work, and microbiologic tests. IE is uniformly fatal without effective therapy. Treatment for most cases requires prolonged courses of bactericidal antimicrobials in doses sufficient to penetrate vegetations and kill the microorganisms. Drug-resistant organisms, prosthetic intracardiac devices, comorbid illness, and valvular dysfunction often complicate therapy, necessitating a look towards adjunctive cardiac surgery. Better data (in the form of population-based surveillance and clinical trials) is beginning to impact the management of infective endocarditis.
感染性心内膜炎（IE）是心内膜表面的感染，通常累及心脏瓣膜和/或心内人工装置。尽管在牙科操作前一直非常强调使用抗菌药物预防IE，但支持这种方法及其有效性的证据却很缺乏。IE会导致瓣膜功能障碍、伴有全身症状的持续性菌血症、栓塞现象和免疫介导性疾病，其诊断需要仔细询问病史、进行体格检查，并利用超声心动图、血液检查和微生物学检测。若不进行有效治疗，IE必然会致命。大多数病例的治疗需要长时间使用杀菌性抗菌药物，剂量要足以穿透赘生物并杀死微生物。耐药菌、心内人工装置、合并症和瓣膜功能障碍常常使治疗复杂化，因此需要考虑辅助性心脏手术。更好的数据（以基于人群的监测和临床试验形式）开始影响感染性心内膜炎的管理。
